Cardiac assessment

this explain about the cardiac assessment in medical and surgical nursing-a practical aspect

1. Cardiac assessment

2. Introduction • Assessment of the cardiovascular system is one of the most important areas of the nurse’s daily patient assessment. This video is designed to be used with the guidelines already in effect at your institution.

3. Important aspects Power of observation. Be as objective as possible.Assess with every tool possible; inspection, palpation, etc. Report your findings as clearly as possible. Clear Charting

4. Articles Needed A Clean tray containing Wrist watch and pen Stethoscope Sphygmomanometer Ruler and inch tape Pen and paper

5. Anatomy of the heart

6. Physiology of the heart Cardiac cycle: Systole and diastole Cardiac output- Amount of blood pumped by the left ventricle per minute Stroke volume- Amount of blood pumped by the ventricle per beat Preload - Volume of blood left in the ventricle at the end of DIastole Afterload- SVR,Amount of resistance of the ventricles to open the aortic valve

7. Cardiovascular assessment

8. Steps Biographical data/Demographic data History: Current health history Past medical history Family history Personal history Risk factor analysis

9. General appearance Look at the client and observe for Does the client lie quietly or restless Can the client lie flat or in upright position Do facial expression reflects pain or distress Are their signs of pallor or cyanosis

10. Basic information Along with general appearance some baseline informations like Body built Consciousness Orientation: To time/Place and Person Body posture Height/Weight and /BMI Should be collected

11. Vital signs Blood pressure: Both hands/Standing/Sitting/Lying Pulse pressure: Systolic- diastolic (Normal 30-40mmhg) Pp increases with Anxiety, Exercise , Bradycardia , Hypertension , Fever,CAD etc Decreases with Shock,Heart failure, Hypovolemia,Mitral Regurgitation etc… Mean arterial pressure: (MAP) ( 2xDiastolic BP) + systolic BP 3

12. Pulse points Pulse should be checked for its Rate,R hythm and Quality. Carotid Radial Brachial Femoral Popliteal Posterior tibial Dorsalis pedis

13. Common signs and symptoms of cardiovascular disease Chest pain/ Discomfort Palpitations Syncope Fatigue Dyspnea Cough Weight gain Edema

14. Skin /Nail Color Texture Warmth Turgor Clubbing of finger Cyanosis Splinter h emorrhage

15. Capillary refill Capillary refill - greater than 3 seconds in case of Dehydration,PVD,Hypothermia and Shock

16. Clubbing of finger

17. Eyes Sclera/Conjunctiva - Signs of anemia Xanthelasma : Yellowish plaques around eye lids A rcus Senilis: Grey ring around iris

18. Neck Thyroid: For enlargement Carotid artery: Bruit Carotid pulse: Rate /Min Pulse deficit:Difference between Apical pulse and Carotid pulse

19. JVP(Jugular Venous Pulsation)

20. Chest Inspection: lesion/Scar/Mass/ Pacemaker Palpation: Precordial heaves: Visible or palpable pulsations/ Thrills PMI (Point of maximum impulse) Apical pulse 5th intercostal space midclavicular region

21. Chest - Auscultation

22. Normal and abnormal sounds S1 - Closure of mitral and tricuspid valve- Best heard in Mitral area S2 - Closure of pulonic and aortic valve- Best heard in Erb’s or Pulmonic area MURMURS:Heard when there is turbulent blood flow within heart. GALLOPS: Pericardial Friction Rub : Caused by inflammation of pericardial sac

23. Abdomen Abdominal aortic pulsation: present i n case of aneurysm Bruits: Hepato jugular reflux: Positive indicates the inability of the right heart to handle increased venous return

24. Extremities Peripheral pulse and Peripheral edema

25. Allen ’s test Assessment of arterial blood flow in Radial and Ulnar artery

26. Ho man’s sign

27. Summary Baseline data / History General appearance Vital signs Skin and Nail Eyes Neck/Carotid Chest JVP/HUX Abdomen Extremities Allen’s test Homan’s sign